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Colorectal emergencies associated with penetrating or retained foreign bodies.

Yildiz SY, Kendirci M, Akbulut S, Ciftci A, Turgut HT, Hengirmen S - World J Emerg Surg (2013)

Bottom Line: Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation.Therefore, nonoperative success rate improves.If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaelı, Izmit, Turkey. selimyigit2002@yahoo.com.

ABSTRACT

Background: Foreign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem.

Methods: Data were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed.

Results: All the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out.

Conclusion: A careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.

No MeSH data available.


Related in: MedlinePlus

Photographs of extracted foreign bodies. (a) shaving foam bottle, (b) bottle, (c) deodorant, (d) glass, (e) metal object.
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Figure 2: Photographs of extracted foreign bodies. (a) shaving foam bottle, (b) bottle, (c) deodorant, (d) glass, (e) metal object.

Mentions: A total of 30 patients, 26 men and 4 women, were admitted with retained rectal foreign body or associated complications. The mean age of the patients were 43 (range, 20–63) years. As for the reason of insertion, 12 patients reported sexual activity, 2 reported an accident in the house and 5 reported that the objects were forcefully introduced into the anus. 11 patients had been unable to state description. Fifteen patients (50%) had high alcohol intake and 3 patients (10%) had psychiatric disease at admission. The most common complaint among the patients was perianal (90%) and abdominal pain (70%). Abdominal X-rays were helpful diagnosis and localization of FB (Figure 1). After the first evaluation in the emergency service, all the patients were hospitalized and evaluation for extraction was carried out in the operating room. Characteristics, localization, type of extraction of foreign bodies were detailed in Table 1. Most of the foreign bodies (23 of 25) were located in the 2/3 distal rectum; remaining 2 FB were located in rectosigmoid junction. Transanal route was the first choice for extraction and it was performed in 23 patients (92%) succesfully. Various surgical techniques such as anal dilatation and digital extraction in 8 (40%) patients, surgical forceps and foley catheters in 10 (50%) patients, and in 2 (10%) patients by means of rectosigmoidoscopy for extraction of rectal FB, have been applied. Figure 2 shows various extracted bodies. Regional anaesthesia was the most common technique for muscle relaxation and it was preferred in 12 (40%) patients. Anal block and intravenous sedation was undertaken in the first 8 (26.6%) and in the remaining 10 (33.4%) patients general anaesthesia was carried out. Seven patients needed emergent laparatomy. Fife of these patients with perforation or severe rectal injury and the remaining 2 patients with failure of transanal extraction. On laparatomy, colotomy, loop colostomy, Hartmann’s procedure and rectal suturation were applied in different patients.


Colorectal emergencies associated with penetrating or retained foreign bodies.

Yildiz SY, Kendirci M, Akbulut S, Ciftci A, Turgut HT, Hengirmen S - World J Emerg Surg (2013)

Photographs of extracted foreign bodies. (a) shaving foam bottle, (b) bottle, (c) deodorant, (d) glass, (e) metal object.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3717008&req=5

Figure 2: Photographs of extracted foreign bodies. (a) shaving foam bottle, (b) bottle, (c) deodorant, (d) glass, (e) metal object.
Mentions: A total of 30 patients, 26 men and 4 women, were admitted with retained rectal foreign body or associated complications. The mean age of the patients were 43 (range, 20–63) years. As for the reason of insertion, 12 patients reported sexual activity, 2 reported an accident in the house and 5 reported that the objects were forcefully introduced into the anus. 11 patients had been unable to state description. Fifteen patients (50%) had high alcohol intake and 3 patients (10%) had psychiatric disease at admission. The most common complaint among the patients was perianal (90%) and abdominal pain (70%). Abdominal X-rays were helpful diagnosis and localization of FB (Figure 1). After the first evaluation in the emergency service, all the patients were hospitalized and evaluation for extraction was carried out in the operating room. Characteristics, localization, type of extraction of foreign bodies were detailed in Table 1. Most of the foreign bodies (23 of 25) were located in the 2/3 distal rectum; remaining 2 FB were located in rectosigmoid junction. Transanal route was the first choice for extraction and it was performed in 23 patients (92%) succesfully. Various surgical techniques such as anal dilatation and digital extraction in 8 (40%) patients, surgical forceps and foley catheters in 10 (50%) patients, and in 2 (10%) patients by means of rectosigmoidoscopy for extraction of rectal FB, have been applied. Figure 2 shows various extracted bodies. Regional anaesthesia was the most common technique for muscle relaxation and it was preferred in 12 (40%) patients. Anal block and intravenous sedation was undertaken in the first 8 (26.6%) and in the remaining 10 (33.4%) patients general anaesthesia was carried out. Seven patients needed emergent laparatomy. Fife of these patients with perforation or severe rectal injury and the remaining 2 patients with failure of transanal extraction. On laparatomy, colotomy, loop colostomy, Hartmann’s procedure and rectal suturation were applied in different patients.

Bottom Line: Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation.Therefore, nonoperative success rate improves.If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Kocaeli Derince Training and Research Hospital, Kocaelı, Izmit, Turkey. selimyigit2002@yahoo.com.

ABSTRACT

Background: Foreign bodies in rectum and colon is an uncommon problem in surgical practice. Anal eroticism leads amongst etiologic factors. In some patients accidents or forceful application of foreign bodies are causative factors. This study was designed to describe our experience in diagnosis and treatment of this exciting clinical problem.

Methods: Data were collected prospectively from 1998 to 2013 in 30 patients. Patient demographics, diagnostic findings, location, type, extraction method, and postextraction period were reviewed.

Results: All the 30 patients were their first admission in emergency service of a hospital. On admission high alcohol intake was determined in 15(50%) patients. All the patients were hospitalized. Most of the rectal foreign bodies (23 of 25) was located distal 2/3 of the rectum. Colorectal perforation was diagnosed in 5 patients who had not any retained foreign body. Under adequate anesthesia transanal extraction was implemented in 23 (92%) patients in the operating room. In the patients with proximal located rectal foreign bodies (2/25), grade III and IV rectal injury or colonic perforation (7/30) laparotomy was carried out.

Conclusion: A careful physical and rectal examination is essential for correct diagnosis and localization of retained foreign bodies. Forceful and repeated efforts without sphincter relaxation is gives rise to proximal migration of objects and unwanted complications such as rectal perforation. The operating room provides adequate anaesthesia for muscle relaxation and technical advantages in transanal extraction of rectal foreign bodies. Therefore, nonoperative success rate improves. If the objects are large and proximally migrated and if the patients suffer from peritonitis due to rectal or colon perforation or pelvic sepsis, laparatomy is performed witout much delay.

No MeSH data available.


Related in: MedlinePlus